Abstract
Aim: Spinal cord injury (SCI)-related flaccid paralysis may result in a debilitating hyperlordosis associated with a progressive hip flexion contracture. The aim of this study was to evaluate the correction of hip flexion contractures and lumbar hyperlordosis in paraplegic patients that had a history of spinal cord injuries.Methods: A retrospective review was performed on 29 hips of 15 consecutive patients who underwent corrective surgeries for severe hip flexion deformity from 2006 to 2018. The mean age at surgery was 10.1 years (2.7 to 15.8), and the mean follow-up was 68 months (7 to 143). Relevant medical, surgical, and postoperative information was collected from the medical records and radiographs.Results: Improvements were seen in the mean hip flexion contracture (p < 0.001) with 100% hip correction at surgery and 92.1% at the latest follow-up. Mean lumbar lordosis decreased (p = 0.029) while the mean Cobb angle increased (p = 0.001) at the latest follow up. Functional score subdomains of the Spinal Cord Independence Measure, Functional Independence Measure, and modified Barthel activities of daily living (ADL) scores remained the same at the final follow-up.Conclusion: For paraplegic SCI patients, we found an association between treating the hip flexion contracture and indirect correction of their lumbar hyperlordosis. We recommend the surgeon carefully examine the hip pathology when managing SCI-related spinal deformities, especially increased lumbar lordosis.
Highlights
Flaccid paralysis after spinal cord injuries (SCIs) may result in variable degrees of loss of function and progressive deformities of the spine and lower extremities
When SCIs occur in the growing child, the challenges that arise are more problematic and differ from those experienced in adulthood; a culmination of abnormal stress and strain exerted and the rapid changes in the architecture of the bones and joints debilitate the child, and a vicious cycle ensues [1,2,3,4]
SCI-related flaccid paralysis mimics the clinical features of poliomyelitis, and an iliotibial band (ITB) contracture is seen in both [5, 6]
Summary
Flaccid paralysis after spinal cord injuries (SCIs) may result in variable degrees of loss of function and progressive deformities of the spine and lower extremities. Inhibited muscular actions and resultant muscle shortening cause myostatic contractures, which, along with neuromuscular imbalances, gravitational stresses, and prolonged shortened malposture, produce joint deformities [1]. Yount [7] and Irwin [8] reported that the poliomyelitis-related ITB contracture is the greatest deforming factor in the lower extremity, resulting in an intractable sequela of the hip. In a growing child, the discrepancy between the increasing length of the lower extremity and contracted ITB causes a progressive flexion and valgus deformity at the knee [4, 7, 8]
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